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Brukaren som kund - Risker med valfrihetssystem inom äldreomsorgen

Simmons, Carin LU (2013) LAGF03 20132
Department of Law
Faculty of Law
Abstract (Swedish)
Kundvalssystem är en organisatorisk modell som ett flertal kommuner infört i äldreomsorgen under 1990-talet och 2000-talet och ännu fler är på väg att införa. Ett kundvalssystem är ett sätt för kommunerna att lägga ut verksamhet i privat regi men där brukarna, till skillnad från vid traditionell upphandling, får välja vilken utförare de vill ha. Leverantörerna av äldreomsorgen får därmed konkurrera med varandra om brukarna såsom om dessa vore kunder och förhoppningen är att detta ska leda till bl.a. en ökad självbestämmanderätt för brukaren och en ökad kvalité och effektivitet i omsorgen. Staten har stöttat denna utveckling bl.a. genom tillkomsten av lagen (2008:962) om valfrihetssystem, som förtydligar kundvalssystemets rättsliga grunder.... (More)
Kundvalssystem är en organisatorisk modell som ett flertal kommuner infört i äldreomsorgen under 1990-talet och 2000-talet och ännu fler är på väg att införa. Ett kundvalssystem är ett sätt för kommunerna att lägga ut verksamhet i privat regi men där brukarna, till skillnad från vid traditionell upphandling, får välja vilken utförare de vill ha. Leverantörerna av äldreomsorgen får därmed konkurrera med varandra om brukarna såsom om dessa vore kunder och förhoppningen är att detta ska leda till bl.a. en ökad självbestämmanderätt för brukaren och en ökad kvalité och effektivitet i omsorgen. Staten har stöttat denna utveckling bl.a. genom tillkomsten av lagen (2008:962) om valfrihetssystem, som förtydligar kundvalssystemets rättsliga grunder. I lagens förarbeten förtydligas också vilka förväntningar som finns på brukarens agerande i valfrihetssystemet, då det är avgörande för systemets funktion att brukaren agerar såsom en strategisk konsument. Undantagsfallet kan avhjälpas genom att den brukare som beskrivs ha inskränkt autonomi på grund av exempelvis sjukdom får hjälp att hitta informationen som krävs för att välja. I uppsatsen framläggs skäl att ifrågasätta om lagens ideal om autonomi motsvarar verklighetens brukare. Detta sker genom att den ekonomiska teorins konstruktion av människan som konsument ställs mot en alternativ teori om människan som tar utgångspunkt i att hon inte är autonom. Dessutom redogörs för empirisk forskning angående det praktiska resultatet av kundvalssystemet som stöder ett sådant ifrågasättande. Med denna kunskap identifieras först risken att intentionerna med lagen inte uppfylls: om systemet inte fungerar som avsett på grund av att brukaren i verkligheten inte beter sig som en kund kan detta leda till att kvalitén på omsorgen och effektiviteten i verksamheten inte ökar. Om brukaren dessutom inte efterfrågar den typ av valfrihet som kundvalssystemet ger, kan det ifrågasättas om brukarens självbestämmanderätt vidgats. Sedan pekas på risken som föreligger i sig med att lagstiftning inte tar hänsyn till människors olikhet och således kan få ett ofördelaktigt utfall för vissa grupper. (Less)
Abstract
The voucher system is an organizational model that several municipalities have introduced into their elder care systems during the 1990s and 2000s and several more are about to introduce such a system. A voucher system is a way for municipalities to outsource operations but where the elder care user, in contrast to traditional procurement, is allowed to choose freely from the different providers. The elder care providers are thus meant to compete with each other for users, as if the users were customers and the hope is that this will lead to, among other things, an increase in self-determination for the user and an increase in quality and efficiency of the care. The government has supported this development through, among other things, the... (More)
The voucher system is an organizational model that several municipalities have introduced into their elder care systems during the 1990s and 2000s and several more are about to introduce such a system. A voucher system is a way for municipalities to outsource operations but where the elder care user, in contrast to traditional procurement, is allowed to choose freely from the different providers. The elder care providers are thus meant to compete with each other for users, as if the users were customers and the hope is that this will lead to, among other things, an increase in self-determination for the user and an increase in quality and efficiency of the care. The government has supported this development through, among other things, the act (2008:962) on system of choice, which clarifies the voucher system’s legal grounds. The legal preparatory works describe how the user is expected to behave in the system of choice, because it is critical to the system’s functioning for the user to act as a strategic consumer. The user who happens not to be able to act in this way, may be helped by being guided to proper information. This paper presents reasons to question whether the law's ideal of autonomy corresponds to a user in reality. This is achieved by putting the economic theoretic construction of the human being as a consumer against an alternative theory of the human being which rather takes the view that the human being is dependent. In addition, the paper provides an account of empirical research on the practical results of the voucher system that supports such a challenge. With this knowledge, the paper first identifies the risk that the intentions of the law may not be met: if the system is not functioning correctly because the user actually does not behave as a customer, this may lead to a non-increase in the quality and efficiency of the care. Furthermore, if the user is not asking for the kind of choice that the voucher system provides, it could be questioned if the user’s self-determination is really expanded. Lastly, the paper points to the risk that if in fact legislation does not take into account people's differences it can have an unfavorable outcome for some groups. (Less)
Please use this url to cite or link to this publication:
author
Simmons, Carin LU
supervisor
organization
course
LAGF03 20132
year
type
M2 - Bachelor Degree
subject
keywords
Socialrätt
language
Swedish
id
4228824
date added to LUP
2014-01-28 17:33:51
date last changed
2014-01-28 17:33:51
@misc{4228824,
  abstract     = {The voucher system is an organizational model that several municipalities have introduced into their elder care systems during the 1990s and 2000s and several more are about to introduce such a system. A voucher system is a way for municipalities to outsource operations but where the elder care user, in contrast to traditional procurement, is allowed to choose freely from the different providers. The elder care providers are thus meant to compete with each other for users, as if the users were customers and the hope is that this will lead to, among other things, an increase in self-determination for the user and an increase in quality and efficiency of the care. The government has supported this development through, among other things, the act (2008:962) on system of choice, which clarifies the voucher system’s legal grounds. The legal preparatory works describe how the user is expected to behave in the system of choice, because it is critical to the system’s functioning for the user to act as a strategic consumer. The user who happens not to be able to act in this way, may be helped by being guided to proper information. This paper presents reasons to question whether the law's ideal of autonomy corresponds to a user in reality. This is achieved by putting the economic theoretic construction of the human being as a consumer against an alternative theory of the human being which rather takes the view that the human being is dependent. In addition, the paper provides an account of empirical research on the practical results of the voucher system that supports such a challenge. With this knowledge, the paper first identifies the risk that the intentions of the law may not be met: if the system is not functioning correctly because the user actually does not behave as a customer, this may lead to a non-increase in the quality and efficiency of the care. Furthermore, if the user is not asking for the kind of choice that the voucher system provides, it could be questioned if the user’s self-determination is really expanded. Lastly, the paper points to the risk that if in fact legislation does not take into account people's differences it can have an unfavorable outcome for some groups.},
  author       = {Simmons, Carin},
  keyword      = {Socialrätt},
  language     = {swe},
  note         = {Student Paper},
  title        = {Brukaren som kund - Risker med valfrihetssystem inom äldreomsorgen},
  year         = {2013},
}